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Differences in utilization and outcomes for laparoscopic versus robotic cholecystectomy in patients with class IV
Austin E Airhart1, Qais AbuHasan1, Dimitrios Stefanidis1
1Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Background:
As the prevalence of class IV obesity (BMI ≥ 50) has continued to rise, the incidence of obesity-related gallstone disease and cholecystectomy in this population has also increased. Yet it remains unclear whether a robotic approach may offer selective benefits for these patients compared to traditional laparoscopic techniques. The objectives of this study are to (1) describe associations between obesity class and operative approach and (2) assess the impact of robotic approach and obesity class on perioperative outcomes.
Methods:
The ACS-NSQIP database was queried from 2022 to 2023 to identify all laparoscopic and robotic cholecystectomies. Patients were stratified by obesity class. Associations between obesity class and operative approach were evaluated with multivariable logistic regression. Multivariable linear and logistic regression models examined associations between operative approach and obesity class with continuous and binary outcome measures, respectively. Sensitivity analysis was subsequently performed to adjust for postoperative biliary diagnosis.
Results:
A total of 99,013 patients underwent minimally invasive cholecystectomy, with 11,951 (12%) cases performed robotically and 2403 (2.4%) with class IV obesity. Patients with class IV obesity were more likely to undergo robotic operations (21.0% vs not obese 11.0%, aOR 1.75, 95%CI 1.56-1.95). While the robotic approach was correlated with increased operative time (β = 9.6, 95%CI 8.8-10.0), it was associated with lower odds of perioperative complications compared to laparoscopic cases (2.5% vs 3.0%, aOR 0.88, 95%CI 0.77-0.99). When adjusted for postoperative diagnosis, the association between the robotic operative approach and lower perioperative complication rate was no longer statistically significant.
Conclusions:
Patients with class IV obesity had increased odds of undergoing robotic cholecystectomy, and while the robotic approach did not improve operative time, it was associated with decreased odds of death or serious morbidity, although this association was likely due to differences in patient selection and case mix.
